0:01

What? Do you been Nanos,

0:03

Cale and Avocados all have

0:05

in common courtesy of. What?

0:09

Is Potassium? What role does

0:11

it play in the body?

0:13

What's a normal range for

0:16

potassium? And what happens when

0:18

potassium is too high or

0:20

too low. In. The body.

0:23

Hi. I'm Allie and owner and

0:25

in one of my favorite apartments

0:27

to work on is the Cardiovascular

0:29

I see. These patients

0:31

are some of the sickest

0:34

of the sick, and their

0:36

clinical picture can really be

0:38

a complex puzzle. And

0:42

patients with wonky lab

0:44

values. Those can

0:46

be especially tricky as tricky

0:48

and complex of lab values can

0:51

be Sometimes though, It's

0:53

not impossible to remember what

0:55

are considered as the normal

0:58

levels and what you need

1:00

to do as the nurse

1:02

to provide the best care

1:05

for your patience when those

1:07

levels of fall out of

1:09

normal range. If you need

1:12

some help, go download a

1:14

free cheat sheet at nursing.com/lab

1:16

Values for a quick reference

1:19

on normal lab values and

1:21

their ranges. A cardinal

1:23

rule of administering ivy

1:25

potassium is that you

1:27

never. Give. It I

1:30

v push. You. May

1:32

have learned this in nursing school

1:34

and it's definitely something that you

1:36

will practice as the nurse. Why?

1:38

Do you think that is? To.

1:40

Answer that: We first need

1:43

to understand what potassium is.

1:45

And. The. Role it plays in

1:47

the body. Potassium. Is

1:50

a critical mineral or electrolyte

1:52

that please a large role

1:54

in electrical impulses in the

1:56

body. Why?

1:58

Do we need to care about? Well.

2:01

What? Do we know about organs

2:03

such as the heart? To

2:06

heart, myocardial cells receive

2:08

electrical impulses that cause

2:11

construction. Which. Makes.

2:13

The heart pumps. Wonky!

2:16

Electrical impulses, Created

2:19

equal. Ineffective something.

2:22

Or. Even lead to

2:24

Deadly A Rhythm years. If

2:27

that happens, the Heart of won't

2:29

have lied effectively to the body.

2:32

To. Eventually the organs will

2:34

fail. To. Help us get a

2:37

picture. Of just how

2:39

important potassium is. I.

2:42

Want to share a patient

2:44

story? That. Actually happens when

2:46

I was working on the C

2:48

V I C U we replaced.

2:51

Electrolytes quite often. Early in my

2:53

career while I was being oriented

2:55

to the unit. I

2:57

held tight did not rule

3:00

of never pushing Ivy potassium.

3:03

Even when my priests

3:05

after was providing instructions

3:07

that conflicted with that.

3:10

Big. Rural. C. V

3:12

patients are often in need

3:15

of electrolyte replacement. Their.

3:17

Labs are closely monitored.

3:20

For. All electrolyte. Said.

3:23

Especially. Potassium.

3:26

And magnesium. For. Cardiac

3:29

concerns. Where. I worked.

3:31

The. Providers placed curing orders

3:34

for electrolyte replacement. And

3:36

the I Cu nurses

3:39

are given the authority

3:41

to pass clinical judgment

3:43

on the when. Replacement.

3:45

Is actually needed. This.

3:47

Is all done in accordance with the

3:50

lab value from the patient. We.

3:52

Had just gotten our patients lab

3:54

results back. And. Upon evaluation

3:57

of the complete metabolic panel,

3:59

We. There were a patient's potassium

4:01

with a low normal limits. Pop.

4:04

Quiz: What are the normal love

4:06

value for potassium? Make. Sure

4:08

to comment below. If

4:20

you said three point five to five

4:22

point zero most of all seater you

4:25

nailed it. If you

4:27

want to take in more challenging place

4:29

to test your knowledge on potassium. I

4:32

put a leak in the description

4:34

follow. Okay, So. Now

4:36

we know a normal range levels and

4:38

my patients dickensian was three point one

4:40

miller chris them for later. So.

4:43

Not too crazy low, but they

4:45

definitely needed a replacement. Being a

4:48

low that lower range of three

4:50

point five mil equivalent for leader.

4:53

Means. That my patient with I spoke

4:55

to limit. The signs and

4:57

symptoms of high school kiwi now

4:59

aren't nearly as scary or emergence

5:01

as those of hyper killing. Yeah,

5:04

Even. Though changes on Scg

5:06

are apparent with for our

5:08

patient was ventilation and sedated

5:10

so we only had objective

5:13

assessment data like the lab

5:15

value. So. We wouldn't

5:17

have been able to assess

5:19

for muscle weakness or linked

5:22

round which are a typical

5:24

hallmark science of hypoglycemia. Other

5:27

signs and symptoms of Hypo

5:29

Kenya include dizziness, heightened tensions,

5:32

and other symptoms involving the

5:34

G I system like nausea,

5:37

vomiting, diarrhea, an abdominal dissension,

5:40

In. Critically low cases,

5:42

even paralytic. Alias.

5:46

Or. Not as common with hypoglycemia as

5:48

it is with hyper to be near.

5:51

There. Can be a Cg changes

5:53

or. His. rhythm years

5:55

and potentially cardiac

5:57

or respiratory arrest Hyperkalemia,

6:01

however, can be much

6:03

more emergent, and signs and

6:06

symptoms can be far more severe,

6:08

far more quickly, especially

6:10

at levels between 6.5 and 7 milliquivalents

6:13

per liter and any higher.

6:19

In hyperkalemia, tall, tented

6:21

and peaked T-waves and

6:23

a widened QRS complex

6:25

can be noticed on

6:28

ECG. If left

6:30

untreated, the QR complex will

6:32

continue to widen and eventually

6:34

mesh with the T-wave. At

6:37

that point, it's almost imminent

6:40

that ventricular fibrillation or

6:43

asystole will occur. Yikes!

6:46

No thanks. Thankfully,

6:49

we were on the less dangerous

6:51

side of the potassium values, with

6:53

our patients' value being only a

6:55

smidge low. Or

6:57

were we? We

7:00

compared the lab value with

7:02

the physician's electrolyte replacement orders

7:05

and went to the med room to grab

7:07

what we needed to replace

7:09

the patient's potassium. We

7:13

were replacing it via IV, so in

7:15

the med room we grabbed the medication

7:17

itself and the tubing required to

7:19

set it up on the pump. Not

7:22

only had I learned to never

7:24

push potassium, I

7:26

learned to never set it up as

7:29

a secondary or what's also known as

7:31

a piggyback. It

7:33

was also the facility policy where

7:35

I was working at the time to

7:37

never set up potassium as a

7:39

piggyback. But

7:42

when we got back to the patient's room, my

7:45

preceptor started instructing me

7:47

to set up

7:50

the potassium on

7:52

a secondary tubing to

7:55

be hooked into the primary

7:57

tubing above the pump. as

8:01

a piggyback. When you set

8:03

up a piggyback, meaning you

8:05

connect the secondary bag to

8:08

the primary bag above the

8:10

pump and

8:13

therefore only running that primary

8:15

line through the pump, there

8:18

is residual medication from

8:21

the secondary or the piggyback

8:23

bag left in the primary

8:25

line, because the

8:27

primary bag and line

8:30

is often used for

8:32

a subsequent compatible medication

8:34

infusion, that residual from

8:36

the previous infusion could later

8:38

infuse into the patient's line

8:40

with that next medication. If

8:44

that subsequent medication runs at

8:47

a faster rate than

8:49

the potassium in this example, which

8:51

is super common, you

8:54

could run the risk of

8:56

inadvertently bolusing potassium

8:59

to your patient. That

9:01

would put you in danger

9:04

of potentially making your patient

9:07

acutely hyperkalemic and

9:11

breaks the rule of never

9:13

pushing potassium IV.

9:17

It's very common on the CVICU for

9:19

patients to have a fluid restriction. So

9:21

the bag of potassium is really small,

9:23

like only 100 mils. So it's tough

9:27

to want to run such a small amount

9:29

on its own through the pump, because

9:32

there's such a high risk of pulling

9:34

air into the line if the infusion

9:36

finishes before the nurse checks back on

9:39

it. But it's an even

9:41

bigger risk and major safety concern

9:43

to piggyback the potassium

9:45

rather than running it on its

9:47

own on a

9:50

primary through the pump. Infusing

9:52

potassium requires close

9:54

monitoring, and in

9:56

most facilities it is typically

9:58

only infused. The. At

10:01

a rate of ten mil equivalence per

10:03

hour. Some. I

10:05

see use will allow for infusion

10:07

as fast as twenty no equivalent

10:09

for our as long as the

10:11

patient is on a cardiac monitor

10:13

and it's running through a central

10:15

line. Rather, Than a peripheral

10:17

liner and Ivy. In. The

10:19

end. I. Refused to set up

10:22

the potassium on a piggyback and

10:24

grub additional to being so it

10:26

could run through the pump on

10:28

it's own line as the primary.

10:31

On a priest after. Was. Super

10:33

Bugs and I dealt with the

10:35

Raf later on. I

10:38

knew I had done the right

10:40

thing, not just according to the

10:42

policy. For. In observance of

10:45

patient safety. whenever.

10:47

I ran potassium. I set it

10:49

up as a primary and why

10:51

site below the pump into Maintenance

10:53

Fluids. As long as there isn't a

10:56

fluid restriction, Otherwise,

10:58

Most of the see the I

11:01

Cu patients have a central line

11:03

where I can connect the potassium

11:05

primary line to infuse it directly.

11:07

Another way that I answer i

11:10

don't pull errands. My line is

11:12

to set a timer to go

11:14

off the five to ten minutes

11:17

before the infusion is set to

11:19

finish so that I can monitor

11:21

the last part of the infusion

11:24

and avoid polling error into the

11:26

line. Additionally, and. Maybe this makes

11:28

me crazy, but once the potassium

11:31

is complete, I. Also run

11:33

the line of just fluids for

11:35

about fifteen to twenty minutes at

11:37

that tend to twenty mil equivalent

11:39

per hour rate on it's own.

11:42

To. Help flush the very end

11:44

of the maintenance fluids using.

11:47

This way I won't risk

11:49

policy any potassium potentially left

11:51

in that line where I

11:53

was cited it. If

11:55

I use that primary set up. For.

11:58

Another piggyback medication. later

12:00

on. As a nurse, you

12:02

will definitely come in contact with

12:05

patients that present with abnormal

12:08

potassium levels. To help

12:10

you quickly spot a patient

12:12

with low or high levels

12:14

of potassium and to remember

12:17

the details about symptoms and

12:20

treatment, don't

12:22

forget to download your

12:24

free cheat sheet at

12:27

nursing.com/labvalues. The link

12:29

is in the description below. I stressed

12:32

about my understanding, passing my

12:34

classes and ultimately passing the

12:36

NCLEX. I found success

12:38

when I started using nursing.com because it

12:40

helped me find the must-know

12:43

information with clear and concise lesson

12:45

videos and then I would check

12:47

my knowledge with the lesson quizzes.

12:50

I used SimCLEX not only evaluate if I

12:52

was ready for the NCLEX but

12:54

it would also give me personalized suggestions

12:56

on what I should study

12:59

to fill in my knowledge gap. I

13:01

could focus on those topics further with

13:03

custom quizzes and use

13:05

the additional study tools that are adapted

13:07

to my personal learning style. I

13:10

hope this has given you a better grasp

13:12

on potassium, what it is, what

13:14

it does in the body and

13:16

what happens when the levels just

13:19

aren't right and how

13:22

to safely administer it

13:24

intravenously. Always remember

13:26

follow facility policy and

13:29

medication administration rules and

13:31

follow the six rights.

13:34

Just keep these tips in mind and you'll

13:37

be ready to tackle anything that comes your

13:39

way. Now go out, be

13:41

your best self today and as always

13:44

happy nursing. This

13:47

has been another episode of The

13:49

Nursing Podcast by nursing.com. Before

13:52

you go don't forget to grab

13:54

the Everything Guide to Mastering Lab

13:56

Values on the NCLEX. Just go

13:58

to nursing.com/ labvalues. That's

14:02

nursing.com/L-A-B-V-A-L-U-E-S.

14:06

Guys, the world needs you. Motivated

14:08

nurses who care. How

14:10

do I know that you care? Well, that's

14:12

easy. You are here, listening to a nursing

14:15

podcast just for fun. Clearly

14:17

your heart is in this. One

14:19

patient at a time, you will help heal

14:21

the souls and bodies of people at their

14:23

most vulnerable. Thank you for this

14:25

journey that you are on. You can do

14:27

this. Happy nursing.